Interictal psychosis of epilepsy: What is the role of the neurologist?

IF 1.8 Q3 CLINICAL NEUROLOGY Epilepsy and Behavior Reports Pub Date : 2024-01-01 DOI:10.1016/j.ebr.2024.100708
Luis Pintor , Felipe Gutiérrez , Andres M. Kanner
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Abstract

Psychotic disorders are more frequent in people with epilepsy than the general population. They constitute one of the most serious psychiatric comorbidities which require an immediate psychopharmacologic intervention. Yet, access to psychiatrists is often limited or not available and the neurologists taking care of these patients are called-upon to start treatment with antipsychotic medication. The purpose of this manuscript is to provide clinicians with pragmatic psychopharmacologic strategies to treat interictal psychotic disorders in patients with epilepsy. We review the case of a 45 years-old man with a 35-year history of treatment-resistant focal epilepsy of bitemporal origin who developed a de-novo psychotic episode that began with insomnia, mood lability and agitation and evolved into paranoid delusions, auditory hallucinations and a thought disorder. The patient was diagnosed with an interictal psychotic episode and was treated with aripiprazole which resulted in significant improvement after reaching a 20 mg /day dose and allowed for the patient to be discharged home. In summary, interictal psychotic episodes of epilepsy are relatively frequent in patients with epilepsy and require of an early psychopharmacologic treatment to facilitate their remission or stabilization until mental health professionals can take over their long-term care. Compared to primary psychotic disorders, interictal psychotic episodes respond better and at lower doses of antipsychotic drugs.

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癫痫发作间期精神病:神经科医生的角色是什么?
与普通人相比,癫痫患者的精神障碍更为常见。它们是最严重的精神并发症之一,需要立即进行精神药物干预。然而,精神科医生的门诊量往往有限或根本无法提供服务,而负责护理这些患者的神经科医生则需要开始使用抗精神病药物进行治疗。本手稿旨在为临床医生提供实用的精神药物治疗策略,以治疗癫痫患者发作间期的精神障碍。我们回顾了一例 45 岁男性患者的病例,该患者有 35 年的位颞原发性局灶性癫痫的耐药治疗史,他出现了新的精神病发作,最初表现为失眠、情绪不稳定和激动,后来演变为偏执性妄想、幻听和思维障碍。患者被诊断为发作间歇期精神病发作,接受了阿立哌唑治疗,在达到每天 20 毫克的剂量后病情明显好转,可以出院回家。总之,癫痫发作间期精神病发作在癫痫患者中较为常见,需要尽早接受精神药物治疗,以促进其缓解或稳定,直至精神卫生专业人员能够接管其长期护理工作。与原发性精神病相比,发作间歇期精神病发作对抗精神病药物的反应更好,剂量也更低。
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来源期刊
Epilepsy and Behavior Reports
Epilepsy and Behavior Reports Medicine-Neurology (clinical)
CiteScore
2.70
自引率
13.30%
发文量
54
审稿时长
50 days
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